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A 40-year-old woman presents to A_E. She is currently 10 weeks

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101   A 40-year-old woman presents to A&E. She is currently 10 weeks
      pregnant. She complains of lower abdominal pain and vaginal
      bleeding. She has had three miscarriages in the past. You are con-
      cerned about the possibility of a further miscarriage. What is the
      most likely aetiological cause if this were true?
      a Fibroids
      b Polycystic ovaries
      c Antiphospholipid syndrome
      d Bacterial vaginosis
      e Cervical incompetence

102   A middle-aged woman who is currently pregnant presents to A&E.
      She complains of lower abdominal pain and irregular bleeding.
      Serum βhCG is 1600 IU. What is the most likely diagnosis?
      a Complete miscarriage
      b Missed miscarriage
      c Septic miscarriage
      d Ectopic pregnancy
      e Threatened miscarriage

103   A 32-year-old woman who is currently pregnant presents to A&E.
      She complains of lower abdominal pain and irregular bleeding. You
      are concerned about the possibility of an ectopic pregnancy. Which
      investigation is most likely to lead to a diagnosis?
      a Serum βhCG alone
      b Abdominal CT scan
      c Serum βhCG and transvaginal ultrasound scan
      d Abdominal X-ray
      e Vaginal swab

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      SBAs AND EMQs IN OBSTETRICS AND GYNAECOLOGY FOR MEDICAL STUDENTS


     104   Which of the following is the most likely site of implantation in an
           ectopic pregnancy?
           a Ovary
           b Cervix
           c Uterus
           d Abdominal cavity
           e Fallopian tube

     105   A 34-year-old woman who is currently pregnant presents to A&E.
           She complains of lower abdominal pain and irregular bleeding.
           You are concerned about the possibility of an ectopic pregnancy.
           She has a past history of pelvic inflammatory disease and currently
           has a Mirena coil in situ. She was previously on the progesterone-
           only pill. What is the most likely aetiological cause for her possible
           ectopic?
           a Mirena coil
           b Pelvic inflammatory disease history
           c Age
           d The progesterone-only pill
           e None of the above

     106   With regards to the menstrual cycle, where is the gonadotropin-
           releasing hormone (GnRH) released from?
           a The anterior pituitary gland
           b The posterior pituitary gland
           c The thyroid gland
           d The adrenal gland
           e The hypothalamus



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107   The main hormone responsible for the ovulatory phase of the
      menstrual cycle is?
      a Follicle-stimulating hormone (FSH)
      b Luteinising hormone (LH)
      c GnRH
      d Thyroid-stimulating hormone (TSH)
      e Progesterone

108   During the luteal phase of the menstrual cycle the corpus luteum
      produces which of the following hormones?
      a FSH
      b LH
      c GnRH
      d Progesterone alone
      e Oestrogen and progesterone

109   Which of the following hormones is responsible for the growth
      and thickening of the endometrium?
      a FSH
      b LH
      c GnRH
      d Oestrogen
      e Progesterone




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      SBAs AND EMQs IN OBSTETRICS AND GYNAECOLOGY FOR MEDICAL STUDENTS


     110   Which of the following hormones is responsible for the vasculari-
           sation of the endometrium?
           a FSH
           b LH
           c GnRH
           d Oestrogen and Progesterone
           e Progesterone alone

     111   The following are all true with regards to the menstrual cycle
           EXCEPT:
           a Menstruation is associated with endometrial necrosis
           b Bleeding lasts for 3–5 days
           c The length of the average cycle is 28 days
           d The average loss of blood is 50–60 mL
           e Menarche usually begins between the age of 11 and
             15 years

     112   A reduction in which of the following hormones is a trigger to the
           start of menstruation?
           a FSH
           b LH
           c GnRH
           d Oestrogen and progesterone
           e Progesterone alone




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113   A 25-year-old woman presents to her GP complaining of unusually
      heavy periods. She comments that she uses at least eight pads per
      day when she is on her period. Routine blood investigations con-
      firm a haemoglobin of 8.2 g/dL. You arrange a set of haematinics
      and request a blood film. What is most likely to be noted on the
      blood film?
      a Pencil cells
      b Hypersegmented neutrophils
      c Pancytopenia
      d Sickle cells
      e None of the above

114   A middle-aged woman presents to her GP complaining of unusu-
      ally heavy periods. She comments that she has noticed clots of
      blood being passed as well. She is a heavy smoker and has a past
      medical history of hypertension. What is the next most appropriate
      step in management?
      a Reassure
      b Combined oral contraceptive pill
      c Mefenamic acid
      d Mirena coil
      e Endometrial ablation




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      SBAs AND EMQs IN OBSTETRICS AND GYNAECOLOGY FOR MEDICAL STUDENTS


     115   A middle-aged woman was diagnosed with menorrhagia by her
           GP approximately two months ago. She was started on appropriate
           therapy but has suffered from irregular bleeding ever since treat-
           ment was commenced. What treatment was she most likely to have
           started?
           a Progesterone-only pill
           b Combined oral contraceptive pill
           c Mefenamic acid
           d Mirena coil
           e Endometrial ablation

     116   A middle-aged woman has been recently diagnosed with menor-
           rhagia by her GP. She has been trialled on mefenamic acid and the
           Mirena coil, which failed to improve her symptoms. Her GP refers
           her for transcervical resection of the endometrium. The follow-
           ing are all common complications associated with this procedure
           EXCEPT:
           a Uterine perforation
           b Infection
           c Bleeding
           d Pregnancy
           e Malignancy




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117   A 43-year-old woman presents to her GP. She complains of sudden
      onset pelvic pain, which occurs approximately two to three days
      prior to her period. She comments that the pain improves typically
      within the first day of bleeding. What is the next most appropriate
      step in management?
      a Heat therapy
      b Mefenamic acid
      c Transcutaneous electrical nerve stimulation (TENS)
      d Acupuncture
      e Fentanyl patch

118   A 16-year-old girl presents to her GP. She is concerned that she
      has not as yet commenced her periods. On examination you note
      evidence of a webbed neck and short stature. What is the most
      likely diagnosis?
      a Turner’s syndrome
      b Marfan’s syndrome
      c Huntington’s chorea
      d Noonan syndrome
      e None of the above




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      SBAs AND EMQs IN OBSTETRICS AND GYNAECOLOGY FOR MEDICAL STUDENTS


     119   A middle-aged woman is brought to her GP by her partner. He
           complains that she often becomes excessively irritable and tearful
           as she approaches her period. He comments that this has been the
           case for the past five years and he feels it is affecting their relation-
           ship. What is the next most appropriate step in management?
           a Olanzapine
           b Imipramine
           c Paracetamol
           d Fluoxetine
           e Risperidone

     120   A middle-aged woman who is currently pregnant presents to A&E.
           She complains of lower abdominal pain and irregular bleeding.
           Routine observations reveal a pulse rate of 140 beats per minute
           and a blood pressure of 90/40 mm Hg. What is the next most
           appropriate step in management?
           a Transvaginal ultrasound scan
           b Abdominal CT scan
           c Urgent laparoscopy
           d Reassure
           e Methotrexate




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121   A 35-year-old woman presents to her GP. She complains of irregu-
      lar periods and acne predominantly on her face. What is the most
      likely diagnosis?
      a Polycystic ovarian syndrome
      b Endometriosis
      c Cervical cancer
      d Fibroids
      e Kallman’s syndrome

122   A middle-aged woman presents to her GP. She comments that her
      periods have stopped. On examination you note evidence of exces-
      sive hair growth on her chin. Which investigation is most likely to
      lead to a diagnosis?
      a Urethral swab
      b Abdominal X-ray
      c Pelvic X-ray
      d Abdominal ultrasound scan
      e Vaginal swab

123   A middle-aged woman presents to her GP. She comments that her
      periods are irregular and that she has noticed her trousers and skirts
      feel tighter than normal. What is the next most appropriate initial
      investigation?
      a Progesterone
      b Thyroid function tests
      c Prolactin
      d LH:FSH ratio
      e Oestrogen



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      SBAs AND EMQs IN OBSTETRICS AND GYNAECOLOGY FOR MEDICAL STUDENTS


     124   A middle-aged woman presents to her GP. She comments that her
           periods are irregular and that her skin feels greasier than normal.
           On examination you note evidence of facial acne and hirsutism.
           What is the next most appropriate step in management?
           a Progesterone-only pill
           b Clearasil®
           c Combined oral contraceptive pill
           d Flucloxacillin
           e Reassure

     125   A 25-year-old woman is recently diagnosed with polycystic ovar-
           ian syndrome. The following are all likely investigative findings
           EXCEPT:
           a Raised testosterone
           b Decreased sex hormone binding globulin
           c Raised FSH
           d Raised LH
           e Normal thyroid function tests

     126   The following are all likely complications of polycystic ovarian
           syndrome EXCEPT:
           a Gestational diabetes
           b Stroke
           c Endometrial cancer
           d Cervical cancer
           e Miscarriage




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127   A middle-aged man presents to his GP. He is concerned that his
      wife has been unable to become pregnant despite regular inter-
      course. He is a heavy smoker and drinker. He requests semen
      analysis. The following are all normal with regards to semen analy-
      sis EXCEPT:
      a A volume of 2–5 mL
      b A sperm count of greater than 8 million per mL
      c A greater than 50% progressive mobility
      d A greater than 15% normal morphology
      e A greater than 25% rapid progression

128   A 35-year-old woman presents to her GP. She is concerned as she
      has been unable to become pregnant despite regular intercourse
      with her partner. Her GP arranges appropriate investigations,
      some of which are shown below. What is the most likely diagnosis?
      LH               15 IU/L
      FSH              5 IU/L
      Testosterone     4 nmol/L
      Prolactin        300 mU/L
      a Hyperprolactinaemia
      b Polycystic ovarian syndrome
      c Sheehan’s syndrome
      d Kallman’s syndrome
      e Uterine fibroids




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      SBAs AND EMQs IN OBSTETRICS AND GYNAECOLOGY FOR MEDICAL STUDENTS


     129   A 55-year-old woman presents to her GP. She complains of irregu-
           lar periods and palpitations. Which investigation is most likely to
           lead to a diagnosis?
           a FSH alone
           b LH alone
           c FSH and LH
           d Prolactin
           e Sex hormone binding globulin

     130   A 54-year-old woman is currently on hormone replacement ther-
           apy. The following are all side-effects of hormone replacement
           therapy EXCEPT:
           a Vaginal bleeding
           b Weight loss
           c Breast tenderness
           d Nausea
           e Headaches

     131   The following are all definite contraindications to hormone
           replacement therapy EXCEPT:
           a Endometrial cancer
           b Vaginal bleeding
           c Pulmonary embolism
           d Deep vein thrombosis
           e Cervical cancer




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132   The following are all associated risks with the use of hormone
      replacement therapy EXCEPT:
      a Breast cancer
      b Bowel cancer
      c Thrombosis
      d Cardiovascular disease
      e Endometrial cancer

133   A 26-year-old woman presents to her GP. She complains of painful
      intercourse and painful periods. Speculum examination reveals the
      presence of blue nodules. What is the most likely diagnosis?
      a Endometriosis
      b Cervical cancer
      c Uterine fibroids
      d Pelvic inflammatory disease
      e Bacterial vaginosis

134   A 27-year-old woman presents to her GP. She complains of painful
      intercourse and painful periods. Which investigation is most likely
      to lead to a diagnosis?
      a Transvaginal ultrasound scan
      b Abdominal ultrasound scan
      c Abdominal X-ray
      d Laparoscopy
      e Pelvic X-ray




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      SBAs AND EMQs IN OBSTETRICS AND GYNAECOLOGY FOR MEDICAL STUDENTS


     135   A 30-year-old woman presents to her GP. She complains of painful
           intercourse and painful periods. Which management plan would
           you instigate first?
           a Total abdominal hysterectomy
           b Laparoscopic uterosacral nerve ablation
           c Reassure
           d Combined oral contraceptive pill
           e Fluoxetine

     136   A 65-year-old woman presents to her GP. She complains of sud-
           den onset vaginal itching and discharge. On examination you note
           the presence of an ulcer on the outer aspect of her labia majora.
           She is referred for appropriate investigations, which demonstrate
           the presence of a vulval tumour less than 2 cm in diameter with no
           nodal involvement. According to FIGO staging what is the most
           likely diagnosis?
           a Stage 1
           b Stage 1a
           c Stage 1b
           d Stage 2
           e Stage 3

     137   A 65-year-old woman is recently diagnosed with Stage 1b vulval
           carcinoma. What is the next most appropriate step in management?
           a Chemotherapy
           b Radiotherapy
           c Reassure
           d Surgery alone
           e Surgery and lymphadenectomy

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138   A middle-aged woman presents to her GP complaining of new
      onset vaginal discharge. Speculum examination reveals the pres-
      ence of an erythematous raw-looking cervix. Current medication
      includes the oral contraceptive pill. What is the most likely
      diagnosis?
      a Cervical polyp
      b Cervical cancer
      c Cervical ectropion
      d Bacterial vaginosis
      e Chlamydia

139   The following are all true with regards to cervical screening
      EXCEPT:
      a In the UK, women between the age of 25 and 49 are
        screened three-yearly
      b In the UK, women between the age of 50 and 64 are
        screened five-yearly
      c A smear is best taken at the end of the menstrual cycle
      d The screening process is non-diagnostic for cancer
      e In the UK, non-sexually-active women are invited for
        cervical screening




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      SBAs AND EMQs IN OBSTETRICS AND GYNAECOLOGY FOR MEDICAL STUDENTS


     140   A middle-aged woman attends a follow-up appointment with her
           GP following a cervical smear. The report states that there is evi-
           dence of moderate dyskaryosis. Which management plan would
           you instigate first?
           a Chemotherapy
           b Colposcopy
           c Reassure
           d Repeat in six weeks
           e Radiotherapy

     141   A middle-aged woman presents to her GP for the results of her
           recent smear test. The report states there is evidence of differentia-
           tion in the upper third of the epithelium with mitotic figures in the
           basal two-thirds. Which management plan would you instigate first?
           a Repeat in six weeks
           b Laser vaporization
           c Diathermy
           d Excision
           e Cryocautery

     142   A 63-year-old woman presents to her GP. She complains of sudden
           onset bleeding vaginally and a purulent discharge. She is post-
           menopausal. Speculum examination reveals the presence of an
           ulcerated cervix. What is the most likely diagnosis?
           a Cervical polyp
           b Cervical cancer
           c Cervical ectropion
           d Candida
           e Chlamydia

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143   A 64-year-old woman is referred for investigation following a
      suspected diagnosis of cervical cancer. Following appropriate
      investigations a cervical carcinoma is confirmed involving the
      vagina but not the lower third segment. According to FIGO stag-
      ing, what is the most likely diagnosis?
      a Stage 1
      b Stage 1a
      c Stage 2
      d Stage 3
      e Stage 4

144   A 65-year-old woman is informed by her GP of a diagnosis of cer-
      vical carcinoma, which has spread to the lower third of her vagina.
      She has a past medical history of chronic obstructive pulmonary
      disease (COPD) and ischaemic heart disease. Which management
      plan would you instigate first?
      a Reassure
      b Urgent chemotherapy
      c Urgent surgery
      d Urgent radiotherapy
      e Repeat biopsy in two weeks




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      SBAs AND EMQs IN OBSTETRICS AND GYNAECOLOGY FOR MEDICAL STUDENTS


     145   A 30-year-old Afro-Caribbean woman presents to her GP. She
           complains of increasingly heavy periods and abdominal discomfort.
           What is the next most appropriate step in management?
           a Reassure
           b GnRH analogue
           c Combined oral contraceptive pill
           d Total abdominal hysterectomy
           e Chemotherapy

     146   A 40-year-old woman presents to her GP. She complains of irregu-
           lar bleeding, which can be heavy at times. The GP refers her for
           appropriate tests as he suspects endometrial cancer. The investiga-
           tions confirm the presence of a carcinoma confined to the uterus
           and cervix. According to FIGO staging, what is the most likely
           diagnosis?
           a Stage 1
           b Stage 2
           c Stage 3a
           d Stage 3b
           e Stage 4a




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147   A middle-aged woman is recently diagnosed with endometrial
      cancer. Investigations confirm the cancer is confined to the uterus,
      more specifically, the inner half of the myometrium. Which man-
      agement plan would you instigate first?
      a Total abdominal hysterectomy with bilateral salpingo-
        oophorectomy
      b Chemotherapy
      c Radiotherapy
      d Repeat biopsy in two weeks
      e Reassure

148   Which of the following is an example of an ovarian tumour that
      accounts for over 50% of all ovarian malignancies?
      a Serous cystadenoma
      b Mucinous cystadenoma
      c Endometrioid carcinoma
      d Clear cell carcinoma
      e Teratoma

149   Which of the following is an example of an ovarian tumour that can
      contain tissue from germs cells of the ovary, hair and teeth?
      a Serous cystadenoma
      b Mucinous cystadenoma
      c Endometrioid carcinoma
      d Clear cell carcinoma
      e Teratoma




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      SBAs AND EMQs IN OBSTETRICS AND GYNAECOLOGY FOR MEDICAL STUDENTS


     150   A woman presents to A&E. She complains of shortness of breath
           and abdominal discomfort. A chest X-ray confirms evidence of a
           right-sided pleural effusion with no evidence of collapse or con-
           solidation. An abdominal ultrasound scan confirms evidence of an
           ovarian mass, which appears benign. She is a non-smoker and has
           no significant past medical or surgical history. What is the most
           likely diagnosis?
           a Serous cystadenoma
           b Mucinous cystadenoma
           c Fibroma
           d Clear cell carcinoma
           e Teratoma

     151   Which of the following is an example of a slow growing, commonly
           malignant ovarian tumour that secretes oestrogen?
           a Serous cystadenoma
           b Mucinous cystadenoma
           c Fibroma
           d Clear cell carcinoma
           e Granulosa cell tumour

     152   Which of the following is an example of a benign ovarian tumour
           that secretes oestrogen?
           a Serous cystadenoma
           b Mucinous cystadenoma
           c Thecoma
           d Clear cell carcinoma
           e Granulosa cell tumour



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153   Which of the following is an example of a malignant tumour that
      has a poor prognosis and accounts for approximately 10% of all
      ovarian cancers?
      a Serous cystadenoma
      b Mucinous cystadenoma
      c Thecoma
      d Clear cell carcinoma
      e Granulosa cell tumour

154   An elderly woman presents to her GP complaining of abdominal
      discomfort. She also comments that her trousers and skirts feel
      looser than normal. She has never had a child and is known to have
      had an early menarche. Which serum investigation is most likely to
      lead to a diagnosis?
      a AFP
      b βhCG
      c Cancer antigen (CA) 125
      d CA 19–9
      e Carcinoembryonic antigen (CEA)

155   Which gene is most strongly associated with the development of
      ovarian carcinoma?
      a NOD 2
      b BRCA 1
      c p53
      d BRCA 4
      e BRCA 6




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      SBAs AND EMQs IN OBSTETRICS AND GYNAECOLOGY FOR MEDICAL STUDENTS


     156   A 70-year-old woman presents to her GP. She complains of
           abdominal discomfort and vaginal bleeding. She has a positive
           family history of ovarian cancer. What is the next most appropriate
           initial investigation?
           a Abdominal X-ray
           b Vaginal swab
           c Endocervical swab
           d Abdominal ultrasound scan
           e Pelvic X-ray

     157   An elderly woman is recently diagnosed with ovarian cancer.
           Following appropriate investigations she is informed that the
           tumour has spread to the fallopian tubes. According to FIGO stag-
           ing, what is the most likely diagnosis?
           a Stage 1a
           b Stage 1b
           c Stage 1c
           d Stage 2a
           e Stage 3

     158   An elderly woman is recently diagnosed with Stage 2 ovarian can-
           cer. What is the next most appropriate step in management?
           a Chemotherapy
           b Surgery
           c Surgery and chemotherapy
           d Reassure
           e Chemotherapy and radiotherapy




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159   A 57-year-old woman presents to her GP. She comments that
      she feels something is coming down through her vagina. She also
      mentions that when she coughs she accidentally passes urine. She
      is morbidly obese and a life-long smoker. What is the most likely
      diagnosis?
      a Posterior vaginal wall prolapse
      b Stress incontinence
      c Genuine stress incontinence
      d Overflow incontinence
      e Anterior vaginal wall prolapse

160   An elderly woman presents to her GP. She comments that she
      feels as if something is coming down through her vagina. She also
      informs you that she has difficulty in opening her bowels. With
      regards to her past obstetric history she is gravida 3, para 3. What
      is the most likely diagnosis?
      a Posterior vaginal wall prolapse
      b Stress incontinence
      c Genuine stress incontinence
      d Overflow incontinence
      e Anterior vaginal wall prolapse




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      SBAs AND EMQs IN OBSTETRICS AND GYNAECOLOGY FOR MEDICAL STUDENTS


     161   A middle-aged woman presents to her GP complaining of acciden-
           tally passing urine when she coughs. She has three children. What
           is the most likely diagnosis?
           a Posterior vaginal wall prolapse
           b Stress incontinence
           c True incontinence
           d Overflow incontinence
           e Anterior vaginal wall prolapse

     162   A middle-aged obese woman presents to her GP. She complains of
           accidentally passing small amounts of urine and feeling a sense of
           incomplete emptying. She has a past medical history of depression
           and is currently on imipramine. What is the most likely diagnosis?
           a Posterior vaginal wall prolapse
           b Stress incontinence
           c True incontinence
           d Overflow incontinence
           e Anterior vaginal wall prolapse

     163   Which management plan would you instigate first in the above
           patient?
           a Fluid restriction
           b Weight loss
           c Pelvic floor exercises
           d Tolterodine
           e Stop imipramine




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164   The following are all risks to the fetus in a pregnant mother with
      chicken pox EXCEPT:
      a Visual disturbances
      b Limb hypoplasia
      c Skin scarring
      d Neurological abnormalities
      e Jaundice

165   The following are all risks to the fetus in a pregnant mother with
      rubella EXCEPT:
      a Cataracts
      b Heart disease
      c Renal failure
      d Hepatomegaly
      e Splenomegaly

166   The following are all true with regards to toxoplasmosis infection
      in pregnancy EXCEPT:
      a The majority of mothers are affected in the second
        trimester
      b Incubation can be up to 20 days
      c It is associated with flu-like symptoms
      d Diagnosis is by serology testing
      e It can be associated with hydrocephalus in the fetus




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      SBAs AND EMQs IN OBSTETRICS AND GYNAECOLOGY FOR MEDICAL STUDENTS


     167   The following are all true with regards to cytomegalovirus infec-
           tion in pregnancy EXCEPT:
           a It has an incubation period of up to 12 weeks
           b It is the least common cause of congenital neurological
             abnormalities
           c It may cause a flu-like illness
           d Primary infection is confirmed by the presence of
             immunoglobulin M (IgM)
           e It may be associated with thrombocytopenia in the fetus

     168   The following are all true with regards to Group B Streptococcus
           infection in pregnancy EXCEPT:
           a The infection affects roughly one-quarter of women in
             pregnancy
           b Risk factors for neonatal infection include pre-term labour
           c Penicillin is the treatment of choice
           d Pyrexia in labour is not a risk factor for neonatal infection
           e Infection is typically asymptomatic

     169   The following are all true with regards to parvovirus infection
           EXCEPT:
           a Transmission occurs via respiratory droplets
           b It has an incubation period of 40 days
           c Diagnosis is made by serology testing
           d It may cause myocarditis in the fetus
           e It may cause anaemia in the fetus




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170   A pregnant woman has been recently diagnosed with Listeria.
      What is the next most appropriate step in management?
      a Doxycycline
      b Penicillin
      c Paracetamol
      d Immediate delivery
      e Reassure

171   Which of the following is the leading cause of death in pregnant
      women?
      a Cardiac failure
      b Stroke
      c Venous thromboembolism
      d Renal failure
      e Anaemia

172   A middle-aged woman presents to her GP complaining of a new
      lesion on her vagina. On examination you note a pustular like
      lesion on her vagina, which is not painful on palpation. She has
      recently returned from Africa and had several episodes of unpro-
      tected intercourse. What is the most likely diagnosis?
      a Chlamydia
      b Gonorrhoea
      c Lymphogranuloma venereum
      d Donovaniasis
      e Chancroid




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      SBAs AND EMQs IN OBSTETRICS AND GYNAECOLOGY FOR MEDICAL STUDENTS


     173   What is the next most appropriate step in management for the
           above patient?
           a Doxycycline
           b Penicillin
           c Paracetamol
           d Excision
           e Reassure




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